Implementación del listado de verificación preoperatorio de enfermería para cirugía segura / Nursing preoperative checklist for safe surgery

ANTECEDENTES: La seguridad en la atención de los pacientes es un aspecto prioritario en la organización y funcionamiento de todo sistema de salud. La valoración de enfermería en las salas de internación permite detectar dificultades o problemas en el preoperatorio que pueden poner en riesgo la vida del paciente o el resultado esperado de la intervención. Se deben generar protocolos que garanticen seguridad para los pacientes disminuyendo al máximo los errores. OBJETIVO: Implementar la lista de verificación preoperatoria de enfermería para disminuir los errores en el ingreso de pacientes a quirófanos. LUGAR: Hospital Universitario-. División Quirófanos - Departamento de Cirugía - Dirección de Enfermería. POBLACIÓN: Pacientes internados para cirugías programadas. MÉTODO: Observacional, exploratorio, longitudinal prospectivo con análisis retrospectivo. Implementación preoperatoria de lista de verificación en sala de internación por enfermería. RESULTADOS: En Mayo de 2018 se operaron 355 pacientes en los quirófanos centrales. Hubo 183 errores de un total de 158 cirugías programadas. La falla más frecuente fue el ingreso de pacientes con ropa interior o ropa de cama en 59 (32,2%), seguido por falta de gorro o cofia en 22 (12%), e ingreso de pacientes con prótesis dental en 21 (11,5%). En la segunda etapa aún con la planilla de verificación de enfermería preoperatoria implementada persistieron los errores en un 48 %. CONCLUSIÓN: se deben promover acciones específicas para que los equipos quirúrgicos alcancen de forma sistemática las medidas de seguridad esenciales sin poner en riesgo la vida y bienestar de los pacientes quirúrgicos

BACKGROUND: The safety of patient care is a priority aspect in the organization and functioning of all health systems with direct implications on the quality of care. The assessment of nursing in the internment rooms allows to detect difficulties or problems in the preoperative that can endanger the life of the patient or the expected outcome of the intervention. This is where protocols must be generated to ensure safety for patients, minimizing errors. OBJECTIVE: To implement the pre-operative nursing checklist to reduce errors in the admission of patients to operating room. SETTING: University Hospital. Surgical Division - Department of Surgery - Nursing management. POPULATION: internal patients for scheduled surgeries. METHOD: Observational, exploratory, longitudinal prospective with retrospective analysis. Checklist preoperative nursing implementation. RESULTS: In May 2018, 355 patients were operated in the central operating rooms. 183 errors were found on 158 surgeries scheduled in a first stage. The most frequent failure was the admission of patients with underwear or bedding 59 (32.2%), followed by lack of cap or cap 22 (12%), and admission of patients with dental prosthesis 21 (11.5%). In the second stage, the nursing check list form was implemented but which could reduce the number of errors in the preoperative period to 48%. CONCLUSION: Specific actions should be promoted so that surgical teams systematically reach essential safety measures that jeopardize the life and well-being surgical patients

Guidelines in Practice: Surgical Attire.

Surgical attire provides a barrier to microorganisms shed from health care workers' skin and hair to help protect patients and promote a clean environment. The AORN "Guideline for surgical attire" includes recommendations for selecting, wearing, and cleaning surgical attire that are based on the highest-quality evidence available. Recommendations are rated as Regulatory Requirement, Recommendation, Conditional Recommendation, or No Recommendation according to the level of evidence, an assessment of the benefits versus harms of implementing specific interventions, and consideration of resources required to implement the interventions. This article discusses guideline recommendations related to laundering surgical attire, wearing long-sleeved attire, and wearing head coverings. A scenario provides an example in which an interdisciplinary facility team uses a gap analysis and a risk assessment to prioritize process changes for implementing the guideline. Perioperative personnel should review the entire guideline for additional information and for guidance when creating and updating policies and procedures.

An Environmental Analysis of Reusable and Disposable Surgical Gowns.

Surgical gowns help protect patients from exposure to microorganisms and serve as personal protective equipment for perioperative staff members. Medical textiles, including surgical gowns, are available as reusable and disposable products. Health care facility administrators and leaders who endeavor to use environmentally sustainable practices require current data for decision making. This study analyzed all activities from the extraction of fossil materials from the earth to the end-of-life disposal of reusable and disposable surgical gowns. The researchers included calculations for laundry and wastewater treatment operations and compared the environmental effects of the two surgical gown systems. The study results showed that selection of reusable gowns rather than disposable gowns reduced natural resource energy consumption (64%), greenhouse gas emissions (66%), blue water consumption (83%), and solid waste generation (84%). Perioperative nurses can use this information to assist facility leaders as they make informed decisions related to gown system selection.

A novel method to teach and assess the sterility of donning sterile gloves.

Sterility is of utmost importance during surgery, particularly orthopaedic surgery. The literature suggests sterility, when compromised, is frequently contaminated at the point of donning sterile gowns and gloves. We describe a novel method to assess the compliance of sterility whilst applying surgical gloves using an ultraviolet lightbox and an ultraviolet-sensitive 'Germ paint'. We carried out an audit of 'sterility' using this method with our surgical trainees. A subsequent educational programme described methods of glove-donning. Repeat assessment yielded significantly improved results. Educating staff using this method may improve sterility in theatre. We believe this is a novel method to teach and assess sterility during glove-donning. The equipment is readily accessible within each NHS hospital. Medical and theatre staff should use this as part of training and departmental induction programmes.

'I decided not to go into surgery due to dress code': a cross-sectional study within the UK investigating experiences of female Muslim medical health professionals on bare below the elbows (BBE) policy and wearing headscarves (hijabs) in theatre.

OBJECTIVES: The objective of this study is to explore the impact of workplace dress code policies and guidance that may influence inclusivity and opportunities in the workplace. DESIGN: Quantitative, self-completion cross-sectional survey. SETTING: British Islamic Medical Association conference. PARTICIPANTS: Eighty-four female medical healthcare professionals with a range of ethnicities and wide geographical coverage. PRIMARY AND SECONDARY OUTCOME MEASURES: The study reports on the experiences of female Muslim healthcare professions wearing the headscarf in theatre and their views of the bare below the elbows (BBE) policy. Percentage of positive answers and their respective 95% CIs are calculated. RESULTS: The majority of participants agreed that wearing the headscarf was important for themselves and their religious beliefs (94.1%), yet over half (51.5%) experienced problems trying to wear a headscarf in theatre; some women felt embarrassed (23.4%), anxious (37.1%) and bullied (36.5%). A variety of different methods in head covering in operating theatres were identified. The majority of respondents (56.3%) felt their religious requirement to cover their arms was not respected by their trust, with nearly three-quarters (74.1%) of respondents not happy with their trust's BBE uniform policy alternative. Dissatisfaction with the current practice of headscarves in theatre and BBE policy was highlighted, with some respondents preferring to specialise as GPs rather than in hospital medicine because of dress code matters. The hijab prototype proposed by the research team also received a positive response (98.7%). CONCLUSIONS: Our study suggests that female Muslims working in the National Health Service (NHS) reported experiencing challenges when wearing the headscarf in theatre and with BBE policy. The NHS needs to make its position clear to avoid variations in individual trust interpretation of dress code policies. This illustrates a wider issue of how policies can be at odds with personal beliefs which may contribute to a reduction in workforce diversity.

Back to Basics: Sterile Technique.

Sterile technique is an essential patient safety principle that reduces the risk of microbial transmission to patients during surgery. The ability to establish and maintain a sterile environment is an important skill for all perioperative team members. Understanding the principles of sterile technique is crucial for anyone entering the perioperative environment. This Back to Basics article reviews sterile technique and the importance of all perioperative team members adhering to aseptic principles.

Surgical attire and the operating room: role in infection prevention.

➤ Although there is some evidence that scrubs, masks, and head coverings reduce bacterial counts in the operating room, there is no evidence that these measures reduce the prevalence of surgical site infection.➤ The use of gloves and impervious surgical gowns in the operating room reduces the prevalence of surgical site infection.➤ Operating-room ventilation plays an unclear role in the prevention of surgical site infection.➤ Exposure of fluids and surgical instruments to the operating-room environment can lead to contamination. Room traffic increases levels of bacteria in the operating room, although the role of this contamination in surgical site infection is unclear.

[Introduction to method for determination of bio-burden on surgical drapes, gowns and clean air suits].

Firstly, the essay introduces the definition of bio-burden, the significance of determination of bio-burden and the specific performance requirements. Then, the essay introduces the method selection and validation on the bio-burden determination of surgical drapes, gowns and clean air suits.

Thermal sensations of surgeons during work in surgical gowns.

Standards for surgical procedures and medical clothing, designed for use in the operating theatre, have been gradually developed with the progress in science and technology. Standard No. EN 13795:2011, determining the requirements concerning materials for production of surgical gowns, was introduced in 2003. It concerns, e.g., resistance to microbial penetration. Little attention is given to thermal comfort, even though it is well known that thermal discomfort can have an adverse effect on the quality and efficiency of work. During a real-life test and laboratory tests, 2 male surgeons and 8 male volunteers were asked to describe their subjective sensations before and after work. The results of the real-life test and the laboratory tests are comparable. They show a clear lack of thermal comfort when medical clothing designed for the operating theatre is used.

Medical textiles that suit the user: predicting health care workers' preference for disposable versus reusable surgical gowns.

Administrators need to balance a variety of factors when purchasing products for a health care facility, including user preference. The objectives of this study were to determine which variables were significantly related to gown preference and then to create a multivariate model to determine the best set of variables for predicting user preference for reusable versus disposable gowns. When "no preference" was included in the multivariate analysis, both occupational group and years employed at the hospital where they currently worked were significant. When no preference data were removed, years employed at the current hospital became the only significant predictor of preference.